Ed Zurga / AP file

Kansas City Chiefs inside linebacker Jovan Belcher, shown in a September game, two months before the 25-year-old killed his girlfriend and committed suicide.

Four months after the NFL sought to curb domestic violence in its ranks by launching a crisis hotline, a bolstered mental-health program and fresh encouragement for troubled players to seek help, that fortified safety net could not prevent the murder-suicide Saturday involving Jovan Belcher. The Kansas City Chiefs linebacker, 25, shot his girlfriend Kasandra Perkins, 22, at their home, then drove to Arrowhead Stadium and killed himself in front of two coaches and the team's general manager.

After the high-profile suicide of retired NFL superstar Junior Seau, 43, last May — two years after Seau drove his car off a cliff following his assault on a girlfriend — NFL commissioner Roger Goodell installed the 24-hour hotline for players and a reinforced mental-health initiative on July 26. That same week, following a spate of NFL-related domestic attacks — at least six other family violence cases in the NFL have been reported since 2010 — Goodell met with the player’s union to discuss possible solutions. 

Yet even as the league was taking steps to help mentally troubled players and their families, the Kansas City Chiefs were aware of Belcher's problems, Kansas City police spokeswoman Sgt. Marisa Barnes told NBC News.

And Police Sgt. Richard Sharp told the Kansas City Star that team officials "were bending over backwards" to help the couple.

The Belcher murder-suicide is the type of nightmarish incident the league has been working harder to prevent, said Robert Gulliver, the NFL’s executive vice president of human resources/chief diversity officer. 

“One of the biggest things that we are trying to do here (in the NFL) is to change the culture, where people realize that it’s OK to seek out help for mental health issues,” Gulliver told NBC News. “We were very deliberate in ... making the point that mental health is part of total wellness, that it’s OK to seek out help for mental health issues because that’s part of your overall well-being."

In addition to help from the team's counselors, Belcher and his girlfriend Perkins, who was mother of his 3-month-old daughter and shared his home, would have had access to the hotline and the league's mental health program. 

At the end of July, the NFL emailed information on its new crisis line and on the league's available mental-health help to the home of every NFL player, Aiello said, adding: "The information is sent with the idea that the player's wife also sees it. If a player's girlfriend sees it, it would be the same thing."

What's more, all 32 NFL teams employ a player development director to help encourage use of the programs, Aiello said.

In addition, the NFL Players Association — the labor union for players — staffs its own 24-hour, toll-free hotline for players to use "if they need any support whatsoever," said George Atallah, NFLPA spokesman. "If a player has an alcohol-addiction problem (for example), he calls in and we route that call to a facility near them, and (facility members) then come pick him up and give him the assistance he needs. That goes for any depression issues and mental health issues." The NFLPA also offers counseling services to players, and it employs a group of retired players "to get a pulse of what’s going on in the locker rooms, handle situations confidentially, and provide support when necessary."

As part of what the NFL calls its “new comprehensive health program” — formally dubbed NFL Total Wellness — Goodell and the league worked with former U.S. Surgeon General David Satcher last summer to strengthen its mental health tools and assistance. The new program encourages players and their families to seek support for behavioral issues, provides health and safety information and offers confidential, free advice via telephone and the Internet. That aid is available to all players and “all members of the NFL family” who find themselves “in times of need,” the NFL says. The same experts who operate the "NFL Life Line" run a similar emergency system for members of the U.S. military.

However, even with best intentions, the NFL remains essentially an elite club in which players have long been trained to hide physical pain — if not injuries — to keep their jobs. That environment could keep players from truly opening up about possible symptoms of depression, anxiety or other mental-health woes.

Gulliver declined to say how many players have phoned the hotline and tapped into the league’s enhanced mental-health program via the web since its launch.

"We don’t publicize the actual usage or percentage numbers," Gulliver said.

As the program has become more widely known by players, however, Satcher said: "The usage of it is increasing."

Gulliver wouldn't comment whether Belcher, his family, friends or any Chiefs players called the crisis line ahead of the murder- suicide, or tried to contact the league’s new mental health services professionals about Belcher.

“That, too, is information that we do not publicize. There are lots of privacy laws that we make sure we uphold. The program is actually administered by the third-party provider so it’s not information that comes into the NFL office. We wanted this to be independent and completely confidential for the members for the NFL family," Gulliver said. 

He added: "Our hearts really hurt for the tragedy that has played out in Kansas City. And we absolutely want to make sure that we provide resources so that people realize there is another way that they can get the help that they need."

Seau’s suicide last May served as the ultimate spark for the new hotline and the league's extra mental-health measures.

“It really did prompt us to step back and say: What more could we be providing for our players and for the NFL family?” Gulliver said. 

But even with a beefed-up program available to players and their spouses, it's difficult to predict this kind of tragedy, Satcher said, adding: "I don’t know that anybody could." 

The American Foundation for Suicide Prevention lists warning signs that someone may be considering suicide due to depression:

• Relentlessly low mood; pessimism; hopelessness; desperation; anxiety or inner tension
• Withdrawal; sleep problems
• Increased alcohol and/or other drug use
• Recent impulsiveness and taking unnecessary risks; threatening suicide or expressing a strong wish to die
• Making a plan; giving away prized possessions
• Sudden or impulsive purchase of a firearm; obtaining other means of killing oneself such as poisons or medications
• Unexpected rage or anger.

Anyone can call the National Suicide Prevention Hotline at 1-800-273-8255.

During the planning meetings for the NFL’s revamped mental-health platform, Satcher said he and league leaders discussed the hot-button issue of chronic concussions sustained by NFL players — and the behavioral instability those injuries are known to carry.

“The brain is a delicate organ and, therefore, head-to-head contact can no longer be viewed as acceptable. The hits start early - in junior high and high school," said Satcher, head of the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta. 

Satcher called the NFL's around-the-clock telephone “lifeline” and the other added mental-health backstops “a major advance” for the league.

Since 2010, these high-profile domestic violence cases have involved NFL players:

• Chad Johnson was released by the Miami Dolphins during the team’s 2012 training camp after the receiver was arrested in early August for allegedly striking his wife in the head.
• Erik Walden, a Green Bay Packers linebacker, was jailed during Thanksgiving 2011, originally charged with a felony after he allegedly assaulted his girlfriend. Later, he received a deferred judgement and agreed to do community service work.
• Dez Bryant, a receiver for the Dallas Cowboys, was arrested in July after allegedly shoving his mother. He was charged with a misdemeanor.
• Seau, a linebacker who spent most of his career with the San Diego Chargers, allegedly assaulted his girlfriend in 2010, two years before he shot himself to death.
• Chris Cook, a cornerback for the Minnesota Vikings, was arrested in October 2011 for domestic violence after he allegedly choked his girlfriend. He was acquitted at trial.
• Brandon Marshall, a wide receiver for the Chicago Bears, has a history of domestic crimes dating back to 2004. In March, he was accused by a 24-year-old woman of punching her in the eye. Marshall’s attorney said Marshall’s wife was the woman injured and that Marshall was a victim in the assault.

The National Suicide Prevention Hotline number is 1-800-273-8255.

Related:

• Details in Belcher murder-suicide emerge as families grieve
• Contact sports leave pattern of brain injuries, study finds

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Reza Estakhrian / Getty Images stock

Even nurses can get squeamish, but it's not always what you'd expect.

The triggers span green, brown and all the vibrant colors of the digestive rainbow. Sudden squeamishness is prompted, for some, by fountains of phlegm and, for others, by certain fragrant excretions.

In the nursing profession, it’s often just called “the one thing” -- that single human function or unappealing appendage that can instantly disgust and distress seasoned medical professionals who otherwise handle all sorts of discharges, emissions and oozing with barely a wince.

“Even though very little in the way of bodily fluids bother me, I do have one thing that sparks the heebie-jeebies,” said Barb Dehn, a women’s health nurse practitioner who has often lectured at Stanford University.

“Despite years of attending births with gushing amniotic fluid, blood and other slimy secretions, doing gynecologic exams on sex workers, and changing dressings for people with gangrene, the one thing that makes me gag is … wait for it … the sight of dentures in a glass. No kidding, I can't stand it and begin to retch every time,” said Dehn, who works at El Camino Hospital in Mountain View, Calif. “When I was caring for some elderly relatives, I could do everything else: change diapers, change oozing dressings, give enemas. But brushing their dentures was just too much for me. Go figure.”

Ask 10 nurses the same question – what is your “one thing?” – and you may hear 10 different answers.

Warning for the easily grossed out: This is stomach-turning stuff.

For Terry Ann Black, who spent 46 years nursing in Vermont and Maryland, it’s “anything having to do with the eyes,” including punctures and foreign bodies.

“Why do eyes bother me? Not really sure, but I think I am afraid that something will gush out of them,” said Black, author of a “Caring is Not Enough,” an end-of-life planning workbook. “I also had a recurring patient who had a fake eye and he would pop it out just to get a reaction. I accommodated him.”

For Sandy Navalta, a certified nursing assistant in San Francisco, the problem is way at the other end.

"The one thing that absolutely grosses me out are situations where a patient has been constipated for days. When the patient is given a stool softener, what comes out is three days of hard stool followed by projectile diarrhea,” Navalta said. “And that diarrhea flows down the leg and into the cast, if the patient is wearing one – and, yes, that has happened to me. I've had to clean it up.”

And for Deonne Brown Benedict, a family nurse practitioner and owner of Charis Family Clinic in Edmonds, Wash., the human juice that makes her woozy her is something with which many of us also struggle.

Her impetus is vomitus.

“I almost didn't become a nurse because I figured I might come in contact with vomit more than once in my career. Thankfully, it hasn't been as frequent as I had envisioned,” said Benedict, who has invested 17 years in the medical profession.

She vividly recalls an early, nursing-student moment when one of her first patients began to hurl. As the woman upchucked, Benedict tossed her an emesis basin, “and went running out of the room so that I wouldn't be the next person to lose it,” she said.

“I happened to see a group of eager medical students looking for a good ‘case study,’ so I pointed them right to my patient. They went right in, probably wondering what had happened to the nurse on duty.”

Benedict “recovered,” she said, from her guilt and her own wave of nausea and forced herself to “toughen up in this area.”

At least in terms of cookie tossings, some people gag when they see others vomit because it’s believed that mirror neurons in their brains make them more empathetic and cause their bodies to emulate what they see. Like forming tears when you see someone crying, experts say.

Following similar logic, Stanford lecturer Dehn theorizes that many nurses have varied causes for their on-the-job cases of the cold sweats because they all are wired differently, and have had distinct life experiences that they can't check at the examination-room door. 

She points to the brain’s limbic system, which help control the body’s reactions to and actions during perceived moments of self-preservation.

“In my own opinion, it must derive from an imprinting that occurs early on in life, and that there are neural pathways that get laid down early and maybe get reinforced throughout life,” Dehn said.

This may explain why Becki Hawkins, a nurse who worked for 30 years in oncology and hospice in the Tulsa area, sites just one aversion when it comes to hands-on human care.

“Not the blood, not the open wounds, not the poo, not the body odor, nor the feet,” Hawkins said.

“The only thing that would really make me scoot out of a room real quick was,” she added, “when a tracheotomy patient would cough up a huge, green ball of phlegm into my face – accidentally and without warning.”

Let's be honest, though, that's going to make pretty much anyone scoot. 

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